Early loading of endosseous implants in the augmented maxilla:A 1-year prospective study

In 10 patients, 68 endosseous implants were inserted in the augmented edentulous maxilla using a one-stage implant placement technique. Three months before implant insertion, the width and height of the alveolar crest were augmented with autologous bone grafts from the iliac crest. In all cases, the resulting bone volume was sufficient for implant insertion. According to an early loading protocol, the implant-supported overdenture was fabricated 2 months after insertion of the implants. Evaluation was performed according to a standardised protocol immediately and 1 year after fabrication of the prosthetic construction. The protocol included assessment of both clinical (bleeding score, pocket depth, implant mobility) and radiographic (marginal bone level on standardised radiographs) parameters. Three implants in two patients in the upper jaw were lost (survival rate: 95.6%). The peri-implant tissues had a healthy appearance and bone loss was minimal. Overall, the patients were very satisfied with the prosthetic construction. From this preliminary study, it is concluded that in selected cases, early loading of implants may develop into a predictable treatment modality after augmentation of the maxilla

Oral rehabilitation with implant-based prostheses of two adult patients treated for childhood rhabdomyosarcoma

Background Rhabdomyosarcoma is the most common malignant tumor in the nasal and paranasal sinus area at childhood. Multimodal treatment for this disorder has severe side effects due to normal tissue damage. As a result of this treatment, facial growth retardation and oral abnormalities such as malformation of teeth and microstomia can cause esthetic and functional problems. Case reports Two cases are presented of patients with severe midfacial hypoplasia and reduced oral function as a result of treatment of rhabdomyosarcoma of the nasopharyngeal and nasal-tonsil region. With a combined surgical (osteotomy, distraction osteogenesis, implants) and prosthetic (implant-based overdenture) treatment, esthetics and function were improved

Vertical distraction of the severely resorbed edentulous mandible:An assessment of treatment outcome

Purpose: To assess the treatment outcome (implant survival, surgical complications, patient satisfaction) of vertical distraction of the severely resorbed edentulous mandible. Materials and Methods: Forty-six patients with severe resorption of the edentulous mandible (bone height 5 to 8 mm, median 6 mm) participated in this study. The anterior segment of the mandible was vertically augmented using the Groningen distraction device. One or 2 months after the last day of distraction, 2 implants (n = 92) were placed. Standardized clinical and radiographic assessments were performed annually, and patient satisfaction was scored on a 10-point rating scale (0 = completely dissatisfied; 10 = completely satisfied). Results: Three implants were lost during the healing phase, but none were lost for the rest of the follow-up period (72 +/- 10.3 months), resulting in an implant survival rate of 97%. One patient developed a fracture of the mandible 3 days after the last day of distraction; it healed uneventfully. The mean mandibular bone resorption during follow-up as measured on radiographs in the midline and distal of the implants was 9.8% +/- 0.6% and 10.2% +/- 0.8%, respectively. In 4 patients radiolucency in the distracted area persisted during the follow-up period. Four patients reported a slight sensory disturbance at the final evaluation visit. All patients functioned well with their prostheses. The mean patient satisfaction score after treatment was 8.1 +/- 1.2. Conclusion: Vertical distraction of the anterior segment of a severely resorbed alveolar ridge of the mandible can provide a proper basis for insertion and osseointegration of endosseous load-bearing implants with good implant survival, few surgical complications, and good patient satisfaction.</p

Dental implant treatment for two adjacent missing teeth in the esthetic region:A systematic review and 10-year results of a prospective comparative pilot study

OBJECTIVES: The aim of the systematic review was to compare studies on implant-supported two-unit cantilever crowns with two adjacent implant-supported crowns in the anterior region. The second aim was to assess in a 10-year prospective comparative pilot study, hard and soft peri-implant tissue changes in patients with a missing central and adjacent lateral upper incisor, treated with either an implant-supported two-unit cantilever crown or two single implant-supported crowns.MATERIALS AND METHODS: Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched (last search March 1, 2023). Inclusion criteria were studies reporting outcomes of two missing adjacent teeth in the esthetic region and treated with a single implant-supported two-unit cantilever fixed dental prosthesis, or with two solitary implant-supported crowns. Outcome measures assessed included implant survival (primary), changes in marginal bone and gingiva level, restoration survival, subjective and objective esthetic scores, papilla volume, mid-facial marginal mucosa level, probing depth, bleeding on probing, and biological and technical complications with ≥1-year follow-up. In addition, in a 10-year pilot study, the same outcome measures were assessed of five patients with a single implant-supported two-unit cantilever crown and compared with five patients with two adjacent single implant-supported crowns in the esthetic zone.RESULTS: Nine articles with 11 study groups were found eligible for data extraction. Meta-analyses of implant survival rates were 96.9% (mean follow-up 3.4 ± 1.4 years) for the implant-cantilever treatment and 97.6% (mean follow-up 3.0 ± 1.8 years) for the adjacent implants treatment (p = .79). In the 10-year comparative pilot study, no clinically relevant changes in hard and soft peri-implant tissue levels occurred in both groups. Patient satisfaction was also high in both groups.CONCLUSION: Single implant-supported two-unit crowns can be a viable alternative to the placement of two adjacent single implant crowns in the esthetic zone.</p

The extremely resorbed mandible, 10-year results of a randomized controlled trial on 3 treatment strategies

Objectives: To prospectively compare the clinical and radiographic results of three modes of implant treatment for implant-retained mandibular overdentures in patients with extremely resorbed mandibles. The three treatment strategies used were (1) a transmandibular implant, (2) augmentation of the mandible with an autologous bone graft followed by placement of four endosseous implants, and (3) placement of four short endosseous implants. Materials and methods: Sixty edentulous patients met the inclusion criteria and were assigned according to a balanced allocation method to 1 of the 3 treatment strategies. Implant survival, surgical retreatment rates, and peri-implant bone loss were assessed according to a standardized protocol during a 10-year evaluation period. Results: During the evaluation period, significantly more implants were lost in the transmandibular implant (cumulative 10-year implant survival rate, 76.3%) and the augmentation groups (88%) compared to the group provided with short endosseous implants (98.8%). The 10-year retreatment rate was significantly more favorable in the endosseous implants only (0%) and augmentation groups (5%) compared to the transmandibular group (30%). In all three groups, there was minor peri-implant bone loss. Discussion: Although implant loss is a frequently used outcome measure for success, the necessity of surgical retreatment seems to be of more relevance for both the patient and the clinician. Conclusion: Considering the favorable clinical and radiographic parameters and the fact that patients can be treated in outdoor clinic setting, the use of short endosseous implants in combination with an overdenture is the first choice of treatment in patients with extremely resorbed mandibles

The extremely resorbed mandible: A comparative prospective study of 2-year results with 3 treatment strategies

Purpose: The aim of this prospective clinical study was to compare the clinical and radiographic results of 3 modes of implant treatment in combination with an overdenture in patients with extremely resorbed mandibles. The 3 treatment strategies used were a transmandibular implant, augmentation of the mandible with an autologous bone graft followed by placement of 4 endosseous implants, and the placement of 4 endosseous implants only. Materials and Methods: Sixty edentulous patients met the inclusion criteria and were assigned according to a balanced allocation method to 1 of the 3 groups. Postoperative complications, implant survival, periodontal indices, change in mandibular bone height, and prosthetic complications were assessed during a 2-year evaluation period. Results: During the evaluation period significantly more implants were lost in the transmandibular implant and the augmentation groups compared to the group with endosseous implants only. Except for the Bleeding Index and the Periotest values, the periodontal parameters did not differ significantly among the groups. In all 3 groups, there was no significant bone loss at most locations. Minimal prosthetic retreatment was necessary. Discussion: Although implant loss is a frequently used outcome measure for success, the necessity of retreatment seems to be of more relevance for both the patient and the clinician. Conclusions: The results of this study suggested that patients with extremely resorbed mandibles can be treated with implants alone in this patient population

Vertical distraction of the severely resorbed edentulous mandible:An assessment of treatment outcome

Purpose: To assess the treatment outcome (implant survival, surgical complications, patient satisfaction) of vertical distraction of the severely resorbed edentulous mandible. Materials and Methods: Forty-six patients with severe resorption of the edentulous mandible (bone height 5 to 8 mm, median 6 mm) participated in this study. The anterior segment of the mandible was vertically augmented using the Groningen distraction device. One or 2 months after the last day of distraction, 2 implants (n = 92) were placed. Standardized clinical and radiographic assessments were performed annually, and patient satisfaction was scored on a 10-point rating scale (0 = completely dissatisfied; 10 = completely satisfied). Results: Three implants were lost during the healing phase, but none were lost for the rest of the follow-up period (72 +/- 10.3 months), resulting in an implant survival rate of 97%. One patient developed a fracture of the mandible 3 days after the last day of distraction; it healed uneventfully. The mean mandibular bone resorption during follow-up as measured on radiographs in the midline and distal of the implants was 9.8% +/- 0.6% and 10.2% +/- 0.8%, respectively. In 4 patients radiolucency in the distracted area persisted during the follow-up period. Four patients reported a slight sensory disturbance at the final evaluation visit. All patients functioned well with their prostheses. The mean patient satisfaction score after treatment was 8.1 +/- 1.2. Conclusion: Vertical distraction of the anterior segment of a severely resorbed alveolar ridge of the mandible can provide a proper basis for insertion and osseointegration of endosseous load-bearing implants with good implant survival, few surgical complications, and good patient satisfaction